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harder enemies
less ammo
no auto save
The biggest difference is the lack of autosaves. You can't continue and you can't rely on autosave to save you if you die. There are plenty of save points despite what the difficulty information says about "reduced typewriters and item boxes" so that's barely an issue but you can only say 5 times or less if you want to achieve an S rank, so you need to spread them out a little more intelligently I guess.